One hundred fifty-four patients with artificial pacemaker (АРМ) and diagnosed CHD with effort angina, functional class II-IV, were included into the trial. The influence of electrocardiostimulation (ECS) on CHD clinic was surveyed. The symptoms had improved in 72 (46, 8 %) patients (Group 1), with decreased frequency of anginal episodes, quantity and doses of antianginal drugs taken, and increased exercise capacity. The opposite was observed in another 30 (19. 5 %) patients (Group 2), with more frequent anginal episodes, changed pain type, localisation and duration, and modified reaction to nitroglycerin. It was explained by electrostimulation associated with 1. 5-2-fold increase in heart rate, raising myocardial О₂ demand, as well as by psychocardial syndrome. In remained 52 patients (33. 8 %) (Group 3), the character of anginal episodes did not react to ECS. Coronary reserve optimisation requires the flexible programming of electroimpulse frequency, according to angina and/or chronic heart failure functional class, and to ECS regimen. In particular, for patients with low coronary reserve, the frequency of 55-56 impulses per min is optimal, and individuals with congestive heart failure need 75-85 impulses per min.

Autonomic regulation and central hemodynamics in patients with coronary heart disease and arterial hypertension were examined. In 107 individuals with CHD, various cardiovascular tests were performed; heart rate variability, central hemodynamic parameters were assessed, with integral rheography in rest and during orthostatic test. All participants were divided into two groups, by presence/absence of arterial hypertension. Comparing to normotensive CHD patients, participants with CHD and hypertension had reduced heart rate variability and elevated initial specific peripheral resistance. Orthostatic test reaction was presented by significant decrease in parasympathic and moderate decrease in sympathic activity, with moderately lowered systolic blood pressure, and mildly raised specific peripheral resistance. These features of autonomic regulation and hemodinamics during orthostatic test in CHD patients with arterial hypertension may affect duration of anginal episode, and angina progression towards myocardial infarction. After test improvement of heart rate variability, comparing to basic levels, is an evidence of controlled physical exercise positive effect on adaptation mechanisms and functional status in patients with CHD, regardless of their blood pressure levels. This is another argument supporting high importance of moderate physical training in rehabilitation of such patients.

Various parameters of unspecific resistance (peripheral blood leucogram, erythrocyte sedimentation rate, integral leucocyte indices, adaptation reaction types, phagocytosis) were assessed in 60 coronary heart disease patients with stable angina, functional status I-IV, and extrasystolia of different prognostic value (benign, malignant). Comparing to healthy controls, among patiens with CHD and extrasystolia, per cent of eosinophils and stick-nuclear neutrophils was elevated, per cent of segment-nuclear granulocytes decreased, neutrophil/monocyte ratio, neutrophil shift, phagocytosis number and index increased. In contrast with « benign» extrasystolia patients, individuals with prognostically « malignant» extrasystoles had unspecific resistance characterised by reduced absolute leucocyte number, per cent of segment-nuclear granulocytes, increased per cent of lymphocytes, leucocytes, lymphocyte-granulocyte general indices, index of lymphocytes/ESR, and decreased intoxication index, leucocyte shift, neutrophil/lymphocyte ratio. Among adaptation reactions in patients with « malignant» extrasystolia, hyperactivation was the most prevalent variant. NBT-test results were decreased.

Immune and hormonal status, together with metabolic syndrome (MS) clinic, were examined in 207 males - car drivers (CD) suffering arterial hypertension (AH), coronary heart disease (CHD) or their combination (mean age 47.7 ± 5. 1). In CD with MS, prevalence of subclinical hypothyrosis (41.5 %) was almost twice as high as in healthy individuals (22.2 %). Besides, among the former, increased levels of leptin, fibrinogen, ACTH, Cortisol, and decreased T-cell immunity were more prevalent than in CD with isolated AH, and in healthy people. Positive correlation between leptin level and increased body weight, TTG, insulin and triglycerides levels was observed.

To study psychological features of patients with coronary heart disease (CRD) or acquired valvular heart disease (AVHD), and to find effective methods of psychotherapy, 51 in-patients (31 individuals with CRD, and 14 with AVHD) treated in Arkhangelsk clinics were examined. For CRD patients, tendency of following existed social standards, «escape into work», orientation on extraneous success criteria were typical. Patients with AVHD were characterised by orientation on emotinal values, «escape into dreams», high value of emotional relations with others. Therefore, psychotherapeutic correction in cardiac patients should be differentiated.

To investigate the relation between uricemia and lipid profile, 539 Arkhangelsk schoolgirls aged 7-17 were examined. With upper norm limit of 0. 31 mmol/l, the prevalence of asymptomatic chronic hyperuricemia among Arkhangelsk girls was as high as 25 %. With uricemia higher than 0. 31 mmol/l, total cholesterol, triglycerides, LDL cholesterol levels were significantly elevated. Mean total cholesterol levels in such individuals were higher than WHO norms of normocholesterolemia for children and adolescents. From the other hand, among individuals with dyslipidemia, uricemia more than 0. 31 mmol/l was diagnosed significantly more frequently. All measured lipid and liporotein parameters directly correlated with uricemia level, and inversely correlated with urate excretion rate, regardless of pathogenetic hyperuricemia mechanisms. Our results point to the fact that chronic hyperuricemia is assosiated with atherogenic lipid/lipoprotein phenotype, observed as early as in childhood, and possibly acts as an indicator of atherosclerosis risk. Therefore, use of a lower norm for population screening seems rational, from position of primary and secondary prevention of atherosclerosis. Our data support detailed examination of lipid metabolism if uricemia is higher than 0. 31 mmol/l.

In experimental models of pathologic humoral homeostasis (acute renal and hepatic failure, metabolic abnormalities in diabetes mellitus, polyorganic insufficiency in so called tourniquet shock, acute cerebrovascular pathology, etc), significant changes in lipid peroxidation (LPO) process have been observed. These changes cause or worsen myocardial electric instability. Clinical evaluation of emoxipin influence on some LPO parameters, QT interval dispersion (QTd), heart rate variability (ИВУ), late ventricular potentials (LVP) was performed in patients with coronary heart disease, diabetes mellitus, and acute cerebrovascular pathology. Principal possibility of myocardial electric instability prevention has been demonstrated, as well as its correction with antioxidant medications (emoxipin, mexidol, dimephosphon, preductal), in experimental and clinical settings of cardiac and extracardiac pathology.

То investigate effect of potassium chloride and its combination with actovegin infusions on cardiohemodynamics and CK, AsAT, myoglobine levels in AMI associated with left ventricular systolic dysfunction, two groups of patients were examined. Participants from the first group (n=26) received infusions of 1 % potassium chloride (4-6 g/d). In the second group, patients (n=23) received infusions of 1 % potassium chloride plus actovegin (0. 15-0. 3 mg/kg/h; 160-320mg/d). Comparative analysis of the data obtained revealed that, after infusion of potassium chloride plus actovegin (0. 15-0. 3 mg/kg/h), left ventriclar volumes reduced, IV contractility improved, BP and cardiac output increased, together with decrease in CVP, HR, DP (double product), and CK activity.

Probability estimation model for diagnostic of coronary atherosclerosis that needs invasive treatment, had been created for patients with various levels of individual risk. For multifactorial analysis with use of neural networks, 19 parameters were selected, including anamnestic data, instrumental examination results, pre-test CHD probability, and individual level of cardiovascular risk. Significant clinico-instrumental predictors were: stress test results, typical angina, myocardial infarction in anamnesis, ECG signs of left ventriular hypertrophy, pre-test CHD probability. A two-level scheme for coronary atherosclerosis diagnostic was developed. This scheme could be used in out-patient settings (screening, selection of candidates for invasive intervention). Its prognostic accuracy is 1. 5-3 times higher than that of traditional clinical decision making procedure.

The study was devoted to parametes of spectral temporal mapping of ventricular complex in coronary heart disease patients taking antianginal drugs of main classes. Eighty patients with stable angina of various functional classes were examined. Parameters of SAECG were registered with computer cardiograph, by standard methodics. All participants were divided into three groups: those taking nitrosorbide, monocinque, and atenolol. Spectral analisis of ECG gives an opportunity to detect local fluctuations of a fixed frequency, which could be used as markers of myocardial electric instability.

 

This review of literature, devoted to arterial hypertension in patients with thyrotoxicosis, describes the state of renin-angiotensin-aldosterone system, catecholamines and Cortisol metabolism, hemodynamic parameters. Pharmacologic correction of hemodynamic abnormalities and lipid metabolism changes is discussed. The information presented supports the conclusion that further study of the problem is necessary. The objective is to investigate neuro-humoral activation and metabolic changes, according to BP increase stage, thyrotoxicosis severity, BP dynamics during thyroid function compensation, and to optimise antihypertensive therapy in such patients.

Mitral valve prolapse (MVP) is the most studied manifestation of connective tissue dysplasia (CTD). Congenital connective tissue defect, lying in the base of the heart anomaly in MVP leads to another internal organs changes. In review the information about extracardial manifestations of CTD concomitant with MVP, such as venous insufficiency, tracheobronchial dyskinesia, gastrointestinal disorders, nephroptosis, genital prolapse, hemostasis pathology is presented.